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813 - 780 -0020 City of Zephyrhills Fire Fax -813- 780 -0021 <br /> Permit Application � <br /> Date 1 1 Received Phone Contact for Permit 11cc�7 I 1 suy b 1 I a-9051 <br /> Owner's Name �LIA... * n L- Owner's Phone Number I g) 3 1 '73 6( <br /> Owner's Address 1 3(, a 9 /Y)c da.ca. Lr) a/ r»P•L fL 3 / 8' - g x a OG I <br /> Fee Simple Titleholder Name I Titleholder Phone Number I 1 1 1 1 <br /> Fee Simple Titleholder Address I <br /> &Ct. / / /VCI 7P—Oh Job Address I i / 6 rhi /J'S & 3 A Sil Lot # I ( <br /> Sub Division Parcel # I � ^ 5 b/3 ID 00000 QPP <br /> n Bio- Hazard Waste Storage - ANNUAL n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> T1 Comm Exhaust Kitchen Hood /Duct n Hood Installation <br /> n Controlled Burn n LP /Natural Gas - Installation <br /> n Emergency Generator < 30 kw n LP /Natural Gas - ANNUAL Sale <br /> 2 Emergency Generator > 30 kw n Places of Assembly- ANNUAL <br /> Fire Protection Maintenance - ANNUAL n Recreational Burn <br /> (Qtrly) ISerni ) MI Other <br /> Sprinkler 0 ❑ ❑ ❑ n Sparklers <br /> Fire Alarm 10" <br /> t ❑ ❑ 2 I 1 n Sprinkler System Installations <br /> Hood Cleaning n ❑ ❑ ❑ I I n Standpipes (Sprinkler Sys) <br /> Hood Suppression n ❑ ❑ ❑ I 1 I-1 Torch Roofing/Tar Kettle <br /> n Fire Alarm Installation n Waste Tire Storage ANNUAL <br /> IT Fire Pumps <br /> n Fire Works <br /> Flammable Application- ANNUAL 1 I Valuation of Project <br /> pi Fuel Tanks <br /> ri Other: I <br /> Contractor Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I <br /> I License # I <br /> ELECTRICIAN /7 /2 Company "I fy:y p f s 2 r. I <br /> Signature /' Svc `f Registered Y / N I. Fee Current Y / N <br /> Address 1 /3/ ("/ 6(G rH Coos- N. Ste AO, derv. ate ?3ikit, License # E- r 000L <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I <br /> J License # <br /> MECHANICAL Company <br /> Signature Registered Y/ N J Fee Current I Y/ N j <br /> Address I <br /> License # I <br /> OTHER Company <br /> Signature Registered Y/ N . 1 Fee Current I Y/ N I <br /> Address I I License # <br /> Directions: <br /> Fill out application completely. <br /> Owner & Contractor sign back of application, notarized (Or, copy of signed contract with owner) <br /> If over $2500, a Notice of Commencement is required (Mechanical work over $5000) <br /> Supply two (2) sets of drawings with applicable documentation <br /> Allow 10 -14 days for review after submittal date. Parcel # - obtained from Property Tax Notice (http: / /appraiser.pascogov.com) <br />